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Does Suboxone Increase Serotonin?

Suboxone can increase serotonin levels, although to what degree hasn’t been fully researched yet. 

When Suboxone is taken as prescribed and not mixed with other medications, this usually isn’t a concern and can even improve your mood. However, especially high serotonin levels can sometimes cause a potentially dangerous condition called serotonin syndrome

How Can Suboxone Affect Serotonin Levels?

While not often discussed and somewhat understudied, evidence suggests that buprenorphine, the key ingredient present in Suboxone and similar drugs, can affect a person’s serotonin levels.[1]

Furthermore, these drugs often seem to help treat serious co-occurring mental health issues beyond opioid use disorder (OUD). In the right circumstances, they have been shown to reduce suicidal ideation, improve depressive symptoms, and help patients feel better overall, allowing them to exhibit a healthier range of emotions and more actively engage in mental health treatment-related activities.

While definitely noteworthy, not all potential effects on serotonin levels and mental health as a result of taking buprenorphine are positive. Buprenorphine has also been linked to causing serotonin syndrome in rare cases, a serious health issue that can cause spasms, severe and illogical agitation, and severely altered mental status, such as believing things that aren’t true.[2] This generally seems to be the result of mixing buprenorphine with antidepressants or migraine medications.

How Does Buprenorphine Affect Serotonin Levels?

The exact way in which buprenorphine may affect serotonin levels is under researched, so there are many questions about this phenomenon that don’t have definitive answers yet. Core to its antidepressant properties seems to be the way it acts on the brain’s opioid receptors, with the kappa opioid receptors in particular known to be key to buprenorphine’s antidepressant properties.

The issue noted earlier related to serotonin, serotonin syndrome, is the result of high levels of serotonin building up in the brain, leading to toxicity.[3] This is a serious central nervous system reaction. While not necessarily directly life-threatening for many individuals experiencing it, it can cause such severe and irrational changes in behavior that people may unintentionally endanger themselves or someone else. If it does occur, serotonin syndrome should be treated as a medical emergency.

Importantly, serotonin syndrome doesn’t seem to be a common issue for those taking buprenorphine-based medications like Suboxone. It’s just important that a doctor is aware of this potential risk and that a patient only takes medications that can affect serotonin levels as prescribed. 

The risk of a serious problem increases significantly if you start taking buprenorphine or an antidepressant of your own accord while already prescribed medications known to affect serotonin levels. Always check with a doctor before taking any medication, even over-the-counter medications, with Suboxone.

Serotonin can broadly be thought of as a “good” chemical, often improving mood. However, like many chemicals, it can cause issues in excess. This is why it’s a good idea to talk with a doctor about how your medication may affect serotonin levels. Contact them right away if you notice sudden, extreme mood changes, especially if you start becoming extremely agitated or are told (or realize yourself) some of what you believe doesn’t seem to make sense.

Use of Antidepressants & Suboxone Together

Many people who use Medication for Addiction Treatment (MAT) like Suboxone also take antidepressants. In fact, use of antidepressants while taking buprenorphine to treat OUD has been shown to improve treatment retention rates.[9]

Certain antidepressants may heighten the effects of buprenorphine or increase the chances of experiencing side effects from Suboxone, so it’s essential to work closely with your doctor to find the right choice for you. For example, the combination of SSRIs, SNRIs, and MAOs with Suboxone could theoretically trigger serotonin syndrome, so it’s important for your doctor to monitor your use.[10]

What Is the Consensus on Suboxone & Serotonin Levels?

While buprenorphine has been linked to rare cases of serotonin syndrome, this is a very uncommon reaction. In one commonly cited case study, the individual was taking other medications in addition to buprenorphine.[2] Other noted instances of serotonin syndrome with buprenorphine use also include use of other medications, such as linezolid.[7]

In most cases, buprenorphine has a positive effect on mood, increasing serotonin levels.[1] If you have concerns about Suboxone’s effects on your serotonin levels, talk to your doctor. They can monitor your mood and other effects to ensure you find the right dose for you. In addition, only take Suboxone as prescribed, and make sure your doctor is aware of any other medications or supplements you are taking.

Symptoms of Serotonin Syndrome

Serotonin syndrome is considered a medical emergency. Look out for these symptoms:[8]

  • Anxiety
  • Agitation
  • Insomnia
  • Pinpoint pupils
  • Disorientation
  • High heart rate
  • High blood pressure
  • Coordination issues
  • Excessive sweating
  • Goosebumps
  • Shivering
  • Headache
  • Diarrhea

When severe symptoms are present, serotonin syndrome can be life-threatening. Severe symptoms include the following:[8]

  • Irregular heart rate
  • High fever
  • Tremors
  • Seizure
  • Unconsciousness or coma

If you notice these symptoms, immediately call 911.

Factors That Impact Your Serotonin Levels

Medications can certainly impact serotonin levels. Many medications used to treat mental health issues, like depression, work by helping to increase serotonin signaling. This isn’t necessarily a concern. It is only generally dangerous if the levels built up in your brain become too high, a risk most doctors are aware of. 

On a related note, some mental health issues, such as depression, can cause a person to have generally lower levels of serotonin in their brain than is typical. Scientists think this is part of what causes their unwanted mental health symptoms. Their brain chemistry may literally be worsening their mood, which is why medication can often help treat their symptoms. Note, however, that not all negative mental health symptoms are primarily caused by low serotonin levels.

Several things can be done to naturally increase serotonin levels.[4] Exercise is one type of activity shown to increase serotonin levels, which is one reason it is known to improve a person’s mood if done regularly. 

Exposure to sunlight and bright light can also help to improve serotonin levels and thus mood.[5] It’s often possible to combine the benefits of sunlight and exercise together by simply engaging in outdoor exercise, such as by jogging or walking outside.

Diet can also potentially impact your serotonin levels, although not to the extreme degree some sources might claim. Tryptophan can get converted into serotonin, although the body doesn’t typically do this very efficiently.[6] Eating tryptophan-rich foods with high-protein foods can help facilitate this conversion, as can getting tryptophan from complex carbohydrate sources, such as fruits, vegetables, and whole grains.[4]

Ultimately, if you are having issues with mood and potentially depression, talk to your doctor. They can craft a tailored treatment plan to help you address the issue. 

  1. Depression: What’s Buprenorphine Got to Do With It? The American Journal of Psychiatry. February 2019. Accessed February 2023. 
  2. Serotonin Syndrome Triggered by a Single Dose of Suboxone. The American Journal of Emergency Medicine. September 2008. Accessed February 2023. 
  3. FDA Drug Safety Communication: FDA Warns About Several Safety Issues With Opioid Pain Medicines; Requires Label Changes. U.S. Food and Drug Administration. March 2016. Accessed February 2023.
  4. Serotonin: The Natural Mood Booster. Harvard Health Publishing. July 2021. Accessed February 2023.
  5. Sunshine, Serotonin, and Skin: A Partial Explanation of Seasonal Patterns in Psychopathology? Innovations in Clinical Neuroscience. July–August 2013. Accessed February 2023.
  6. Influence of Tryptophan and Serotonin on Mood and Cognition With a Possible Role of the Gut-Brian Axis. Nutrients. January 2016. Accessed February 2023.
  7. A Case Series on Serotonin Syndrome from Concomitant Use of Linezolid With Methadone, Buprenorphine, and/or Dextroamphetamine. Journal of Pharmacy Practice. June 2023. Accessed January 2024.  
  8. Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions. International Journal of Tryptophan Research. September 2019. Accessed January 2024.
  9. Association Between Receipt of Antidepressants and Retention in Buprenorphine Treatment for Opioid Use Disorder. Journal of Clinical Psychiatry. April 2022. Accessed January 2024.
  10. Buprenorphine/naloxone Drug Interactions. British Columbia Centre on Substance Use. Accessed January 2024.

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